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Psychological Impact of Asthma
in Children
Kristin A. Kullgren, Ph.D.
Presentation Outline
• Psychological adjustment in children
with asthma and their families
• Family correlates of non-adherence
• Time for discussion and questions
Protective Factors That
Promote Adjustment in
Childhood Chronic Illness
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Temperament
Social support
Peer relationships
Motivation
Problem-solving
skills
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Self-efficacy
Parent adjustment
Family resources
Family cohesion
Low family conflict
Risk Factors for
Poor Adjustment in Childhood
Chronic Illness
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Low socioeconomic status (SES)
Major life events
Poor family functioning
Longer duration of illness
Greater functional impairment
Greater illness severity
Psychological Adjustment in
Children With Asthma
• Psychological factors are not
initiating causes of asthma
• Asthma is a risk factor for maladjustment
• Maladjustment not more common with
asthma vs. other chronic illnesses
– 10-35% children with adjustment problems
Psychological Adjustment in
Children With Asthma
• Greater risk for internalizing vs.
externalizing problems
– More symptoms of anxiety than other
chronic illnesses
• 35% with DSM-IV anxiety disorders
– Simple phobia
– Separation anxiety
– Generalized anxiety disorder
Psychological Adjustment in
Children With Asthma
• Other issues in kids with asthma &
anxiety
– Poorer self-esteem
– More activity restrictions
– Lower social competence
Why Anxiety?
• Similar physiological experience
• When you can’t breathe, its scary!
Psychological Adjustment in
Teens With Asthma
• 39% report fearing death from asthma
• 63% report feeling anxious
– Social anxiety
– Dating anxiety
• Less likely to date
Psychological Adjustment in
Teens With Asthma: Importance
of Peers
• 39% disclose to friends
• 29% embarrassed to have attack in
front of peers
• 38% bring inhaler when leave house
– More likely if feel can control asthma
– Less likely if embarrassed by asthma
Relationship Between
Psychological Adjustment and
Asthma Symptoms
• More severe asthma
– Higher levels anxiety
– More behavior problems
• More behavior problems
– More days of wheezing
– Poorer functional status
• But it’s a two-way street!
Parenting the Child
With Asthma
• Higher levels of criticism with their children
• Mothers
– Involved more physically and emotionally
• Fathers
– Involved less physically
– More critical regarding school absences
– More face-to-face contact associated with better
asthma outcomes
• 5 hours/day
Psychological Adjustment in
Moms of Children With Asthma
• Half report significant depression
– Unemployed
– Lowest income category
– Lower quality of life
• Those w/high depressive symptoms are
40% more likely to take child to ED
Psychological Adjustment in
Moms of Children With Asthma
• Caregivers w/clinically significant mental
health problems
– Children twice as likely to be hospitalized
• Children with greater asthma morbidity
– Moms with depressive symptoms
– More negative life stressors
• Report >8 undesirable events last year
• Chaotic family life
– More hospital admissions asthma
Prevalence of Non-Adherence
• Acute Disease - 30%
• Chronic Disease - 50%
• Childhood Asthma
– Rates of adherence average around 50%
– 28.6% children using meds as prescribed
– 41% teens cannot name their medications
– Poor adherence related to asthma
exacerbations
Adherence: Patient & Family
Correlates
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Demographics
Knowledge
Adjustment & coping
Parental monitoring
Division of responsibility
Previous adherence
Beliefs & expectancies
Adherence: Who’s Doing What?
• Asthma self-management is occurring
by ages 4-6
• School or home circumstances vs.
developmental readiness
– Parent employment status
– Independence in other areas
• Children’s inhaler use skills
– 60% parents rate child’s skill as excellent
– 7% observed to be effective
Adherence: Who’s Doing What?
• Allocation of family responsibilities
for asthma
– Disagreement between children and
caregivers
• Children report more responsibility for
themselves than mothers report
• Caregivers overestimate adolescent
responsibility
– Leads to non-adherence and functional
morbidity
Adherence: Who’s Doing What?
• Average # of asthma caregivers is > 3
– 1/3 with > 4 caregivers
• Responsibility for medication monitoring
is often confused
– Daycare provider, parent, grandparent,
siblings, child, school
• Need to clarify who does what!
Adherence: Parent Beliefs
• Belief that child is vulnerable
– More likely to use regular preventive meds
– Take child to doctor
– Keep home from school
• Belief that child is not vulnerable
– May discontinue medication
Adherence: Parent Beliefs
• Caregivers with negative expectations of
their ability to manage asthma
– Increased asthma morbidity
• Belief that asthma is episodic vs. chronic
• Negative perceptions of medications
Adherence: Family Functioning
• Poorer asthma adherence
– Families with high conflict
– High levels of child behavior difficulties
Summary
• Children with asthma are at risk for
maladjustment, primarily anxiety
• Parent/family factors can impact asthma
morbidity and adherence